Though proven to offer superior outcomes versus other treatment regimens, less than half of patients receive standard of care for locally advanced cervical cancer, according to a study published in Gynecologic Oncology.
For the study, researchers led by Christine M Fisher, MD, MPH, University of Colorado, Aurora, utilized the National Cancer Database to identify patients with cervical cancer and evaluated utilization trends and factors associated with receiving standard of care therapy, which includes pelvic external beam radiation (EBRT) with chemotherapy and interdigitated brachytherapy.
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Among 15,194 patients included in the study, 44.5% received standard of care treatment. These patients had significantly improved overall survival compared with those who were treated with other means.
High volume centers, academic centers, comprehensive community cancer centers, private insurance, and higher income, were all associated with an increased likelihood of receiving standard of care, while patients with a low socioeconomic status and black race were less likely to receive standard of care.
Additionally, researchers found that 26.8% of patients received no radiation boost, 23.8% received an EBRT boost only, and 49.5% of patients received EBRT with brachytherapy. EBRT boost was superior over no boost at all, but overall survival was highest among those who received brachytherapy.
Thus, researchers concluded that standard of care for cervical cancer is being underused and that there are significant disparities in regards to which patients receive standard of care treatment. In theorizing why this effective treatment strategy is so underused, Dr Fisher called attention to the costs of many of the procedures and the ability of some small practices to afford standard of care.
"A lot of this has to do with the fact that brachytherapy requires equipment and expertise," Fisher says. "And there's no substitute for it. We see some patients whose care is managed in less specialized settings coming to University of Colorado just for the brachytherapy component of their treatment. Others simply miss out on this important piece of their care."
"We have a couple take-home messages," she added. "First is that virtually all of these cervical cancers are preventable with vaccination against the HPV virus and by screening, which can catch the precursors of cervical cancer before the development of the disease itself. By far, the best solution is prevention. Then if a woman does develop cervical cancer, she should look for a center that offers brachytherapy. It's critically important."
